儿童孤立性脾脓肿的保守治疗。

Conservative management of isolated splenic abscess in children.

机构信息

Department of Pediatric Surgery, Lady Hardinge Medical, College and Kalawati Saran Children's Hospital, New Delhi 110001, India.

出版信息

J Pediatr Surg. 2010 Feb;45(2):372-5. doi: 10.1016/j.jpedsurg.2009.10.074.

DOI:10.1016/j.jpedsurg.2009.10.074

PMID:20152354

Abstract

INTRODUCTION

Isolated splenic abscesses (SAs) are rare in children. We report a single-center experience with emphasis on their diagnosis, etiology, treatment, and outcome.

METHODS

This is a retrospective review.

RESULTS

Eighteen children (age, 3-16 years; male-female ratio, 5:1) were managed over a period of 8 years in a tertiary-care institution. Presenting symptoms included fever, abdominal pain, and anorexia. Splenomegaly was present in 12 (67%), leukocytosis in 9 (50%), and thrombocytosis in 12 (67%) patients. Associated diseases were thalassemia (1), tuberculosis (1), and typhoid fever (9). Solitary and multiple SAs were seen in equal numbers. Blood culture grew Salmonella paratyphi A in 1 case. Splenic aspirate culture was positive in 3 (Escherichia coli [1], S paratyphi A [1], Acinetobacter [1]). Widal serology was positive in 9 (50%) patients. Management consisted of intravenous broad-spectrum antibiotic therapy in all patients, together with percutaneous aspiration in 10 (56%) cases where the abscess size was greater than 3 cm. All patients responded, and complete resolution was observed.

CONCLUSION

Isolated SA in children responds favorably to conservative treatment with intravenous broad-spectrum antibiotics and percutaneous drainage without the need for splenectomy.

摘要

简介

孤立性脾脓肿（Splenic abscesses，SAs）在儿童中较为罕见。我们报告了单中心的经验，重点介绍其诊断、病因、治疗和结局。

方法

这是一项回顾性研究。

结果

在一家三级医疗机构中，8 年间共治疗了 18 例（年龄 3-16 岁；男女比例 5:1）儿童孤立性脾脓肿患者。主要表现为发热、腹痛和食欲不振。12 例（67%）患者存在脾肿大，9 例（50%）患者白细胞增多，12 例（67%）患者血小板增多。相关疾病包括地中海贫血（1 例）、肺结核（1 例）和伤寒（9 例）。单发和多发脾脓肿的比例相同。1 例患者血培养出甲型副伤寒沙门菌，3 例（大肠杆菌 1 例，甲型副伤寒沙门菌 1 例，不动杆菌 1 例）患者脾抽吸物培养阳性。9 例（50%）患者肥达氏血清学阳性。所有患者均接受静脉广谱抗生素治疗，脓肿大小大于 3cm 的 10 例患者接受了经皮抽吸治疗。所有患者均有反应，完全缓解。